Where we’re at: Far apart on Seattle’s drug crisis

Editor’s note: The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team. As part of this project, editorial writer Alex Fryer has been examining issues related to behavioral health and substance use disorders.

Meeting people where they are at.

In the region’s battle against substance abuse, this mantra is sacrosanct public policy. It dictates that those seeking to help others don’t judge or cajole. It’s about building trust so that incremental steps can be made toward guiding someone to a safer, better life. The approach dovetails with what’s called “harm reduction” — lowering the personal and societal costs of potentially dangerous behaviors. Example: needle exchanges to prevent HIV transmission between intravenous drug users.

As with any orthodoxy, there are heretics. In Seattle, they are few.

At a Seattle City Council briefing on overdose prevention efforts, Councilmember Sara Nelson asked whether there was any data about whether city-funded programs that included handing out pipes to users smoking fentanyl or methamphetamine led to anyone seeking treatment.

“There are folks who don’t want to stop using drugs. There are folks for whom abstinence is not something by which they measure success in life,” answered Amber Tejada of the Hepatitis Education Project. “Ultimately, bodily autonomy is key.”

At the same briefing, Brad Finegood of Public Health — Seattle King County added: “We want to be able to help people wherever they are at further the goals that they have. Maybe one day they’ll stop using drugs and maybe one day they won’t, but what’s really important is that we do good by these people.”

That it was Nelson who asked a question about the efficacy of publicly funded fentanyl pipes is no coincidence. On the council, hers is often the lone voice questioning whether meeting people where they are at is really the best policy in the midst of a drug and death crisis.

Fentanyl is 100 times more potent than morphine. Made in clandestine labs, there is no quality control, and it varies widely in strength. The Drug Enforcement Agency reports that 42% of pills tested for fentanyl contain a potentially fatal dose. Among those on the front lines of this public health crisis, there is general agreement: fentanyl robs its users of time to get better.

Nelson is far from alone in saying the challenge is urgent. But in stressing treatment, she is fighting a battle almost single-handedly. Listen to her thinking.

“I’m wanting to hear from the outreach people that they are actually trying to move people,” Nelson said in an interview. “Meeting people where they’re at and harm reduction is committed to not changing behavior. They’ll say they help people not die. But at some point you have to move beyond that. You can’t just be maintaining people because the next hit may be the last.”

Nelson has been open with her own struggles with alcohol addiction and her experience with treatment. But she also makes clear that her personal story is not a prerequisite to pushing for a different approach. The numbers, she says, speak for themselves.

Data released earlier this year by the Centers for Disease Control and Prevention show that Washington experienced the single highest increase among U.S. states in reported drug overdose deaths between April 2022 (2,349) and April 2023 (3,155), an increase of 34%. Seattle is the epicenter of the state’s worsening drug crisis.

On the streets, there is a parallel effort to help people that is not publicly funded and makes no pretense of meeting people where they are at. In fact, it pushes treatment from the first conversation.

“We’ll pick up the phone (to a treatment facility) right there. I’ve had a grown man weep in my arms and say, ‘nobody has ever tried to get me into treatment,’” said Andrea Suarez of We Heart Seattle. The largely volunteer group started out picking up trash and cleaning after encampments in 2020. Now, it is also focused on getting people into detox. People like William.

Suarez and Tim Emerson, We Heart Seattle’s only other paid employee, bumped into William sitting on a Lower Queen Anne sidewalk on a recent sunny Friday afternoon. Emerson had known him for about three years, always living unsheltered.

On this day, William, 47, a professed methamphetamine user, said he was ready to get help. Suarez and Emerson helped him pack a few belongings and piled into a van.

“Strike when the iron’s hot. We’re going right now,” said Suarez.

First stop was the state Department of Licensing’s Queen Anne location to get temporary identification needed for job and housing programs after William spends a few days in detox. That is the challenge: lining up working arrangements and housing in what’s called “sober living” immediately after leaving medical treatment, so people don’t fall back to old routines and bad friendships.

Waiting for his number to be called at the DOL, William sat between Emerson and Suarez, who asked him for his mother’s phone number. Suarez sent her a text: “I’m with your son William and we’re taking him to detox and I’d like to talk to you.”

William’s mother called back a few moments later. “They say they might be able to get me into a treatment program today. I wanted to call and let you know what is going on,” William told her. It’s been something his mother has waited a long time to hear, she told Suarez when he handed her the phone.

This is the first time William has tried treatment, he said. “I’ve always said no. I don’t want to be looked at like a rag tag bum. Don’t want people to feel I was dirty or dangerous. Don’t want that.”

Suarez made calls to see if there was any space in Valley Cities Behavioral Health Care: Recovery Place Seattle, a facility where William could safely withdraw from meth. The voice mail was full and not taking messages. So they all decided to drive over in person and see what they could do.

Strong emotions

The choice of whether to ask people about treatment versus “meet them where they are at” stirs strong emotions. We Heart Seattle is pilloried by some homeless activists as too focused on cleaning encampments and shaming people for substance use disorders. On the organization’s board of directors is Michael Shellenberger, author of “San Fransicko: Why Progressives Ruin Cities.”

University of Washington surveys of people who use drugs show 70% were interested in medication to help with opioid addiction, and 54% were interested in detox.

When Seattle Councilmember Nelson asked about sober-living facilities for people leaving detox at a recent council briefing on gaps in services for people using fentanyl, the reaction was sharply negative and personal.

“You had access to get treatment for yourself, right? But most of our people who have Apple Health (state health insurance) don’t get the same great access to treatment that you received, right?” countered Deaunte Damper, a community activist with VOCAL-WA.

“That’s the problem I’m focusing on,” responded Nelson from the dais.

“But, to swing it back,” Damper said, “when you are talking about sober living in our communities, we are more focused on meeting people where they are at.”

After the meeting, I connected with another of the panelists, Febben Fekadu, housing director of Evergreen Treatment Services. Its REACH program connects people experiencing homelessness with everything from food and clothing to medical care, shelter, and mental health and substance use treatment.

Her agency supports 20-30 clients each month in sober-living facilities, mostly through a program that focused on people leaving jail.

“A lot of our clients have expressed that recovery is something they want to work on but it’s too challenging while they’re unhoused because their basic needs are not met,” she said. “We support clients who want to work towards their goals. If the client’s goal is to work toward recovery and sobriety, I don’t know of any organization or homeless provider that’s not going to support their client towards that goal.”

Fekadu lamented that the panel discussion with Nelson seemed so needlessly adversarial. “I think we all want to see people do well and not suffer and have their basic human needs met. It’s just that we haven’t figured out how to agree on the path toward that.”

The wait for detox

Back at the parking lot of Recovery Place Seattle, Emerson said he secured an appointment for William the following week. But this was Friday.

“Someone is this motivated, got the ID, got the detox appointment, called his mom, wants to get a job — high level of motivation — we do not want to let him back on the streets,” said Suarez. She took out her phone and booked William a hotel room downtown for three nights.

“William, you want a king or two queens?” she asked him.

“Two queens is better than one!” he joked back.

Although Emerson will have a room key and plans to check in on William over the weekend, the question remains: Will he stick around until his detox appointment the following Monday?

The treatment front

The City of Seattle’s human services budget is $319 million for 2023. We Heart Seattle operates on about $500,000 annually from grants and donations.

Nelson wants to see more public money fund treatment and sober living, even if it means cutting a check to one of the many recovery centers around the region, state or nation. Costs to support one person range from $500 to $10,000 a month in a private facility.

And the council member wants to see the city Human Services Department direct outreach workers to be more active in presenting treatment as a viable option.

“We’ve made a policy decision to spend a lot of money on everything from outreach to permanent supportive housing. We should at least put some energy into examining what more we could do on the treatment front,” she said. “We have to try harder instead of just meeting people where they are at. That is not working.”

Uncertain future

After checking in on William several times throughout the weekend, Emerson drove him from downtown to the Beacon Hill detox facility first thing Monday morning. William enrolled with the hope that he would stay a month.

He walked out after a few days, put off by feeling “institutionalized,” he told Suarez. In the week since, William has stopped by We Heart Seattle’s donated downtown offices a few times and asked about re-enrolling in treatment. The offer to pay for a halfway house still stands, Suarez told him. At press time, his future is unknown.

With seven of nine council seats up for grabs, the Nov. 7 election will determine whether Nelson, in the middle of her four-year term, continues to be alone in wanting to see a more varied and aggressive approach to the drug crisis that is killing so many and wrecking so much.

Or, alternatively, new lawmakers could choose to up the city’s game when it comes to offering treatment, funding sober living facilities, and helping with job placements.

That is the choice many Seattleites may not even realize they face.

The terrible odds of fentanyl demand we put egos to rest. No one has a monopoly on compassion. That acknowledgment should be the first step in a new way of thinking.